Measures for Preventing Postoperative Complications after Mandibular Reconstruction with Free Fibular Flaps

Postoperative complications, such as orocutaneous fistula and local wound infection, are common after head and neck reconstruction, especially mandibular reconstruction. From 2000 through 2002, the authors performed mandibular reconstruction using free fibular osteocutaneous flaps in 28 patients, with the following three measures intended to reduce the frequency of these complications. First, bony fixation with titanium miniplates was performed directly on the periosteum to avoid separating the periosteum from the cortex of the fibular bone. Second, the dead space below the reconstructed mandible was eliminated by using the flexor hallucis longus muscle, which was harvested with the fibula graft. Third, the surface of the reconstructed mandible was covered with a part of the de–epithelized skin island. When these three measures were applied, major orocutaneous fistula was eliminated and the frequency of local infection was reduced.

Although these measures to prevent postoperative complications were effective, several complications still developed. Therefore, two additional measures were applied. The first additional measure was to harvest the flexor hallucis longs muscle longer than required for the fibula bone to eliminate the dead space around the conjunction of the reconstructed mandible. The second was to harvest the free fibular flap from the ipsilateral side to the mandibular defect.